PLEASE FILL OUT THE SIGN UP FORM BELOW
AND WE WILL CONTACT YOU ASAP! updated -
April 2014

You MUSThave the
following criteria:

1) a minimum FLORIDA
Class E learners LICENSE (or another state or other country license) to
participate,
...and...
2) be of GOOD HEALTH
...and...
3) can RIDE A BICYCLE ACTIVELY NOW!

NAME:
(as appears on DL)

ENTER
YOUR NAME, ABOVE, EXACTLY
AS STATED ON YOUR DRIVERS LICENSE

YOUR NICK NAME:
(if applicable)

EMAIL ADDRESS:

Which course are you interested in?

Basic RiderCourseSM

Experienced RiderCourseSM

If you are interested in an Experienced RiderCourse...We will compile all requested dates and contact you
when we schedule a class

OR...

What is your DOB?
(Date of Birth)

enter as: xx/xx/xx

How did you hear about Easy Rider?

What has been
(if any) your past experience in motorcycle riding,(not as passenger, but as a "DRIVER")

street, dirt bike, off road, etc?

Do you CURRENTLY RIDE a motorcycle?
(not as a passenger)

If
yes, what are you
CURRENTLY RIDING NOW?

Phone number(s),

Cell?
Work? Home?

also please inform us as to when is thebest time to reach you.

Mailing addressPlease include your zip code. Thank you

List which dates you would like
to be scheduled for. We can not guarantee these until a representative from Easy Rider
contacts you.

COMMENT OR QUESTION:

Post
any comments
and/or questions

We will contact you ASAP regarding REGISTRATION.
Thank you, again, for "stopping by"!

HIT SUBMIT ONLY ONCE, PLEASE

SIGN UP TODAY!
CONTACT Easy Rider Motorcycle Safety Training Staff

Our MSF Certified Classes are in
cooperation with the

Flagler County Adult and Community Education.

You MUST
fill out the "online form" to register. Classes fill up QUICKLY!

Once you fill out the ONLINE
CONTACT FORM,
an EASY RIDER MOTORCYCLE SAFETY TRAINING REPRESENTATIVE
will email you back, informing you if that class is filled or not.

You may pay by
check, cash or credit / debit card

Please note- Being a STATE
CERTIFIED PROGRAM, NO REFUNDS can be made.This is NOT a private lesson program,
... you ARE in a group situation.Acceptance in the class does not guarantee successful completion.
You MUST keep pace with the rest of the class.